Provider Demographics
NPI:1447568605
Name:RAIHA, ALLISON M (RD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:RAIHA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:M
Other - Last Name:RAIHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2905 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4274
Mailing Address - Country:US
Mailing Address - Phone:217-877-9117
Mailing Address - Fax:217-877-3077
Practice Address - Street 1:2905 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4274
Practice Address - Country:US
Practice Address - Phone:217-877-9117
Practice Address - Fax:217-877-3077
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003874133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered